Freedom Magazine – Florida Undercounts Psych Drug Related Deaths

The bad news: “Legal” drugs are killing more Floridians than street narcotics, according to recent reports by the state’s Medical Examiners Commission. The commission found deaths in Florida related to prescription drugs outnumber deaths from illicit drugs three to one.

The really horrible news: That’s only a fraction of the problem with the so-called “legal” drugs. Pharmaceutical companies have aggressively fought tabulating the deaths involved in the use of many killer drugs—generally called antidepressants and antipsychotics. Likewise missing from the medical examiners’ report is any accounting of deaths from other dangerous drugs such as Ritalin, a stimulant widely abused on the streets and often prescribed to children who are classified as having “attention disorders.”

Despite authoring the report, the Florida medical examiners have shrugged off including the psychiatric drugs among the killer pharmaceuticals. Yet, studies linking the drugs to fatalities—and many of those deaths are children—have been thwarted by indifference from those officials, and by funding “research” by malleable academics, who then endorse the drugs and disparage critics who are rightfully alarmed at the spike in drug-related deaths.

Psychiatrist Wayne Goodman

In Florida, for example, a major purveyor of the spin of pharmaceutical companies is Wayne Goodman, former head of the University of Florida Department of Psychiatry. Goodman has received at least 51 grants from the companies that make and market deadly drugs, and has used his position to assist the drug companies’ agendas. The professor has even fought efforts that would have allowed parents to be advised, and potentially object, when schools refer students to mental health counseling—often resulting in children being prescribed dangerous psychiatric drugs.

The transformation from skeptical scholar to corporate shill was evident in a panicky email Goodman sent to a colleague: “I need you to compile data ASAP so that we can refute” assertions about the lethality of the drugs, Goodman wrote.

TABULATING THE DRUG DEATHS

The news about Florida’s mounting death toll from prescription drugs is well known. The medical examiners’ study, for example, was detailed in a 2008 New York Times article that stated: “The Florida report analyzed 168,900 deaths statewide. Cocaine, heroin and all methamphetamines caused 989 deaths, it found, while legal opioids—strong painkillers in brand-name drugs like Vicodin and Oxycontin—caused 2,328.”

What is less known is that many psychiatric drugs also contribute to large numbers of deaths, but those fatalities are not tallied in many official reports. It took the efforts of Ken Kramer, an investigator from Citizens Commission on Human Rights, a psychiatric watchdog group established by the Church of Scientology in 1969, to spotlight the undercounting of drug-related deaths. Based on information obtained under Florida’s Public Records Law, Kramer concluded that because certain drug-related deaths are not recorded under the state’s current system, the problem was much worse than reported by the medical examiners’ study or by media reports.

By studying all child suicides in Florida from 2000–2004 and collecting all medical examiner files and many related law enforcement records on each case, Kramer found that at least 38 percent of the children who killed themselves during that period had been prescribed psychiatric drugs. Some had even used their medication to commit suicide.

Kramer unearthed enough data to document that at least 52 percent of Florida’s child suicides had a history of psychotropic drug use or psychiatric treatment of some kind.

He studied the document that formed the basis of the New York Times story— the annual report published by the Florida Medical Examiners Commission. It purported to concern “Drugs Identified in Deceased Persons by Florida Medical Examiners” and included alcohol, illicit drugs (such as cocaine, marijuana and heroin), and certain prescription drugs, including stimulants, tranquilizers and opiate-based painkillers.

But Kramer found it omitted two major classes of psychiatric drugs—antidepressants and antipsychotics. These two categories of drugs have resulted in so many deaths that they require “black box” warnings on their packaging—the Food and Drug Administration’s most severe cautionary note. Deaths from other dangerous prescription drugs, such as Ritalin, were also omitted from the commission’s report.

While exact statistics are unknown, extrapolating from the FDA’s MedWatch program that monitors adverse reaction reports for approved drugs, 63,000 persons taking antidepressants committed suicide between 1997 and 2006.

In its 2011 report, the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network revealed an increase of 109 percent between 2005 and 2011 in hospital emergency room visits due to adverse reactions to antidepressants and antipsychotics, with a total of 181,690 emergency room visits in 2011 alone due to these two types of drugs.

The same report found that of 228,366 drug-related suicide attempts in 2011 that resulted in emergency room visits, 30 percent involved antidepressants and/or antipsychotics, while only half that amount involved the use of opiates or opioids.

“Who knows what the accurate ratio of prescription drug deaths to illicit drug deaths really is, because all prescription drug deaths are not tracked and analyzed in Florida,” Kramer said.

Armed with documentation to show that antidepressants and antipsychotics have high potential for abuse, Kramer brought his concerns to the Florida Medical Examiners Commission.

At a commission meeting (audio here) on August 13, 2008, then Chairman Stephen Nelson said, “Mr. Kramer has requested that antipsychotics and antidepressants be added to the drugs tracked in the Drugs in Deceased Persons Report due to their black box death warning labels. Mr. Kramer is concerned that there are not any statistics on these types of drugs.”

With little discussion, however, Nelson determined not to include these types of drugs in the report. The decision was based not on examination of objective statistics, but rather on off-the-cuff opinions of those present, such as that of one medical examiner, Vernard Adams: “I don’t think it’s that big of a problem.” Larry Bedore of the Pinellas-Pasco Medical Examiner’s Office said he thought the intent of the annual report was to track street drugs and illicit drugs, “not so much prescription drugs”—even though the vast majority of drugs tracked are prescription drugs.

The meeting ended with Nelson stating they were not going to add these types of drugs into the report and suggesting Kramer talk to the Florida Office of Drug Control in the Executive Office of the Governor.

DRUGMAKERS’ DAMAGE CONTROL

Kramer would later learn, after obtaining documents from the Office of Drug Control, that the office had received a copy of his study more than two years earlier. Indeed, a flurry of emails had flown between the Office of Drug Control and its then head, Jim McDonough, and the University of Florida’s Department of Psychiatry in February 2006.

The records reflect the unwillingness of McDonough and Wayne Goodman, then chairman of the university’s Department of Psychiatry, to truthfully examine the effects of psychotropic drugs. Without bothering to contact Kramer about his report or the records he used in preparing it, McDonough emailed Goodman: “I believe I am hearing a facetious argument being made against psychotropic medications.”

In 2005, Goodman fought a Florida bill that required public schools to obtain informed consent from parents before referring students for mental health services. Such a referral brings with it high risk for the child to be put on brain-damaging psychiatric drugs. The measure—supported by Citizens Commission on Human Rights and others— passed both the Florida House and Senate before being vetoed by Governor Jeb Bush. Goodman, learning of a press conference at the State Capitol concerning the legislation, emailed McDonough’s office: “If there is another circus event of this kind please [line] me up as one of the dancing bears. Seriously, I think you need me there.”

Curiously, Goodman was the chairman of the FDA advisory panel which recommended the black box warning on antidepressants in 2004. Then, at the same time he was fighting the simple tracking of deaths caused by antidepressants, he was conducting a study, published in the journal Psychopharmacology in March 2007, which found that the risk of suicide in antidepressants was even higher than found by the FDA when it ordered the black box warnings. Then again, in 2009, Goodman contributed to a newsletter published by the Florida Psychiatric Society which attempted to debunk the FDA black box warnings on the relationship between antidepressants and suicide by clarifying “Myths About Antidepressants and Suicide.” Today, Goodman is chair of the Department of Psychiatry at Mount Sinai School of Medicine in New York. He has also recently served as a consultant and speaker for Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Roche and Solvay.

Of note, Bruce Goldberger, a colleague of Goodman, coauthored with Pinellas-Pasco Medical Examiner Jon Throgmartin a March 2011 report for the Centers for Disease Control and Prevention that documented an 84 percent increase in Florida prescription drug deaths between 2003 and 2009. In their editorial comments, they admitted their reporting was deficient for several reasons, including that “the analysis did not include all drug overdose deaths in Florida.”

Kramer said, “It’s astounding to me that antidepressants and antipsychotics are excluded from the state’s annual report. Adding them would be a simple administrative matter and would surely give a more accurate report and assist the state in devising strategies to combat the harm these drugs may be causing to the citizens of this state.”

Clearwater pharmacologist Pamela Seefeld explained the importance of a complete analysis of drug deaths, including antidepressants and antipsychotics. “There is a known danger in certain combinations of these drugs leading to death but this is not well understood by doctors and scientists,” she said. “If these types of drugs were included in the report the findings could be analyzed for use by medical practitioners to avoid dangerous combinations and save lives.”

John F. Sugg, award-winning investigative journalist, was senior editor at Creative Loafing alternative newspapers and held senior writing and editing positions at The Miami Herald, Tampa Tribune and Atlanta Constitution.